Adapted from "Diarrhea" module, Pre-Service Health Training for Volunteers Binder Peace Corps Office of Medical Services

INTRODUCTION

The objectives of this module are to:

• Define diarrhea
• Present information on the major causes and symptoms associated with diarrhea
• Provide students with guidance in when to seek medical attention for diarrhea
• The Food and Water Preparation Module is designed to complement this module and presents information on the prevention of diarrhea. If possible, it is recommended that these two modules be done together.

Students should understand the following:

1. Knowing when diarrhea requires medical attention
2. Knowing when to recognize and manage dehydration

DEFINITION

Diarrhea can be defined as the passing of frequent, loose or watery stools more than 4 times per day. Recognizing person-to-person variation in what is "normal," it is often useful to define diarrhea as change in bowel function with stools that are too loose or too frequent for the individual.

SCOPE OF THE PROBLEM

The incidence of diarrhea varies significantly in different countries. In some countries, diarrhea is the most commonly reported health problems among some Study Abroad students.

CAUSES OF DIARRHEA

A useful way to discuss diarrhea is to divide underlying causes into non-infectious and infectious.

WHEN MAY DIARRHEA REQUIRE MEDICAL EVALUATION AND TREATMENT?

Diarrhea may be an isolated symptom or may be associated with other signs and symptoms. Common associated signs and symptoms include:

• Nausea and vomiting
• Loss of appetite
• Bloating and gas
• Abdominal cramps and pain
• Fever
• Rash
• General weakness or feeling faint
• Achiness, malaise and headache
• Blood in stool
• Mucous in stool

IMPORTANT

Among the various signs and symptoms associated with diarrhea, the ones that should alert the student to seek medical attention are:

Fever

Blood or mucous in stool

Diarrhea lasting more than 3-5 days

TREATMENT

• All diarrhea is "treatable" in the sense that the complication of dehydration can be avoided with adequate fluid replacement (See Complications)
• Oral Rehydration Therapy (ORT), which replaces fluid, salt, and sugar, is important to start early and continue throughout diarrheal illness: one liter treated water/ 2 tbs. Sugar/1/2 tsp. Salt, one cup administered after each loose bowel movement.
• Frequent small, soft feedings as tolerated may be instituted early. Milk, milk products, alcohol, caffeine, oily foods and foods high in roughage (fresh vegetables) should be avoided.
• Motility-inhibiting agents (Imodium/Lomotil) reduce cramping and frequency of diarrhea, but may cause toxic dilation of the colon in inflammatory bowel disease and bacterial or amebic dysentery-they should not be used when fever, abdominal pain, or bloody stools are present. Short-term use for travel is widely practiced, and is generally safe.

COMPLICATIONS

• Dehydration is the most common complication of diarrhea.
• Students should be able to recognize early sign and symptoms of dehydration:
• Thirst
• Dry mouth
• Reduced urine output
• Weakness and lightheadedness
• Other more serious complications or diarrhea include systemic infection (sepsis), bowel perforation, and liver abscess (amebiasis).

Adapted from "Diarrhea" module, Pre-Service Health Training for Volunteers Binder Peace Corps Office of Medical Services